Plantar Fascia

FAQs Heel Pain

FAQs Heel Pain

My heel hurts, does this mean I have a heel spur?

The foot is designed with a large ligament called the Plantar Fascia that attaches from the bottom of your heel bone and fans out to your forefoot. A heel spur is a secondary result of chronic small tears to the attachment of this ligament on your heel bone. It is possible to have many small tears over your lifetime, stimulating a heel spur to grow, and you would never know about it. What typically causes actual heel pain is the tearing of this plantar fascia ligament itself, not the spur. However, it is possible to have problems with both the fascia and a spur. It is important to seek the help of a physician to clearly identify the problem.

My heel used to only hurt when I first stepped down in the morning and got better the more I walked. Now the heel hurts all the time and gets worse as the day goes on, why is that?

Initial pain upon first stepping down on your foot in the morning, or upon first getting up from sitting during the day is a typical symptom of plantar fasciitis. However, as the condition goes untreated, other tendons and ligaments become affected and involved as well. One tendon that commonly gets overlooked is the Posterior Tibial Tendon, whose function is to hold up the arch of your foot. If you are having persistent heel pain throughout the day, it is very important not to ignore these symptom changes and see your podiatrist.

My doctor told me the best way to treat Plantar Fasciitis is stretching my calf muscles. What do my calves have to do with this?!

When we walk, the natural progression of the step involves the heel hitting the ground, followed by the rest of our foot, and ending by pushing off with our big toe. This normal step progression allows your body to be propelled forward into the next step using both your calf muscles and the plantar fascia ligament on the bottom of your foot. If your calf muscles are tight, your heel is unable to come all the way down to meet the ground, causing your foot to land flat on its heel and midfoot. This kind of strike leads to your calf muscles doing hardly any work and all the stretch needed to propel your next step forward comes from only that plantar fascia ligament on the bottom of your foot. Overstretching and overworking this ligament is the cause of inflammation and pain.

Diabetic Foot Care

Diabetic foot care is imperative to your overall health and can be dangerous to your feet with possible serious consequences. Diabetes can cause nerve damage that takes away the feeling in your feet. In many cases, numbness or tingling in the feet is the first clue patients have of their new diabetes diagnosis. Diabetes may also reduce blood flow to the feet, making it harder to heal an injury or resist infection. Because of these problems, you may not notice injury or blisters to your feet, often resulting in diabetic foot ulcers. Ulcers often lead to infection or a nonhealing wound that could put you at risk for an amputation. To avoid serious foot problems that could result in losing a toe, foot or leg, follow these guidelines provided by the American College of Foot and Ankle Surgeons at

Inspect your feet daily. Early detection is key!! Check for cuts, blisters, redness, swelling or nail problems. Use a magnifying hand mirror to look at the bottom of your feet. Call your doctor if you notice anything. Avoid blisters; if you have shoes that are giving you blisters, talk to your doctor about special diabetic shoes and inserts

Bathe feet in lukewarm, never hot, water. Keep your feet clean by washing them daily. Use only lukewarm water—the temperature you would use on a newborn baby.

Be gentle when bathing your feet. Wash them using a soft washcloth or sponge. Dry by blotting or patting and carefully dry between the toes.

Moisturize your feet but not between your toes. Use a moisturizer daily to keep dry skin from itching or cracking. But don’t moisturize between the toes—that could encourage a fungal infection.

Cut nails carefully. Cut them straight across and file the edges. Don’t cut nails too short, as this could lead to ingrown toenails. If you have concerns about your nails, consult your doctor. IF YOU HAVE NEUROPATHY OR BLOODFLOW ISSUES- your nails should be trimmed by your Podiatrist!

Never treat corns or calluses yourself. No “bathroom surgery” or medicated pads. Visit your doctor for appropriate treatment.

Wear clean, dry socks. Change them daily.

Consider socks made specifically for patients living with diabetes. These socks have extra cushioning, do not have elastic tops, are higher than the ankle and are made from fibers that wick moisture away from the skin.

If your feet get cold at night, wear socks. Never use a heating pad or a hot water bottle.

Shake out your shoes and feel the inside before wearing. Remember, your feet may not be able to feel a pebble or other foreign object, so always inspect your shoes before putting them on.

Keep your feet warm and dry. Don’t let your feet get wet in snow or rain. Wear warm socks and shoes in winter. If your feet may get wet (especially in the Northwest!), carry and extra pair of dry socks

Consider using an antiperspirant on the soles of your feet. This is helpful if you have excessive sweating of the feet.

Never walk barefoot. Not even at home! Always wear shoes or slippers. You could step on something and get a scratch or cut, resulting in dangerous foot ulcers!

Take care of your diabetes. Keep your blood sugar levels under control.

Do not smoke. Smoking restricts blood flow in your feet.

Get periodic foot exams. Seeing your foot and ankle surgeon on a regular basis can help prevent the foot complications of diabetes.

Follow up with your Primary Doctor or Endocrinologist regularly for help managing your diabetes

To find out what Diabetes-specific care our office can offer you, click:

For more information of how to care for your feet and other common foot conditions, go to or


Diabetes and Diabetic Neuropathy- Help, my feet are numb and tingling!

Diabetes and Diabetic Neuropathy- Help, my feet are numb and tingling!

Diabetes and your Nerves: Diabetic Peripheral Neuropathy

Diabetic neuropathy is nerve damage caused by diabetes. Diabetic peripheral neuropathy does not emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy. Neuropathy causes loss of feeling in your feet, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation, eventually causing slow or non-healing foot ulcers that can become infected. This serious complication of diabetes can lead to loss of a foot, a leg or even a life.  . Three different groups of nerves can be affected by diabetic neuropathy:

  • Sensory nerves, which enable people to feel pain, temperature and other sensations
  • Motor nerves, which control the muscles and give them their strength and tone
  • Autonomic nerves, which allow the body to perform certain involuntary functions, such as sweating


The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly managed diabetes. However, even patients living with diabetes who have excellent blood sugar (glucose) control can develop diabetic neuropathy. There are several theories as to why this occurs, including the possibilities that high blood glucose or constricted blood vessels produce damage to the nerves.



Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.

For sensory neuropathy:

  • Numbness or tingling in the feet
  • Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

For motor neuropathy:

  • Muscle weakness and loss of muscle tone in the feet and lower legs
  • Loss of balance
  • Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:

  • Dry feet
  • Cracked skin


To diagnose diabetic peripheral neuropathy, the foot and ankle surgeon will obtain the patient’s history of symptoms and will perform simple in-office tests on the feet and legs. This evaluation may include assessment of the patient’s reflexes, ability to feel light touch and ability to feel vibration. In some cases, additional neurologic tests may be ordered.


First and foremost, treatment of diabetic peripheral neuropathy centers on control of the patient’s blood sugar level. In addition, various options are used to treat the painful symptoms.

Medications are available to help relieve specific symptoms, such as tingling or burning. Sometimes a combination of different medications is used. Discuss with your doctor the use of Vitamin B Complex to help reduce some of the symptoms.

In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.


The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include:

  • Keep blood sugar levels under control.
  • Wear well-fitting shoes to avoid getting sores.
  • Inspect your feet every day. If you notice any cuts, redness, blisters or swelling, see your foot and ankle surgeon right away. This can prevent problems from becoming worse.
  • Visit your foot and ankle surgeon on a regular basis for an examination to help prevent the foot complications of diabetes.
  • Have periodic visits with your primary care physician or endocrinologist. The foot and ankle surgeon works together with these and other providers to prevent and treat complications from diabetes.

To see what services we can offer our diabetic patients, click:

For more information, and the rest of this article, see the entry on https://www.

Diabetes and Holiday Food – Tips for Success

Diabetes and Holiday Food – Tips for Success

Are you dreading the holiday season and feel there is no way you can control your diabetes AND enjoy yourself at the same time? This is a very common concern among my diabetic patients around this time of year. But you CAN be successful and indulge yourself with a few changes to your holiday approach. Here’s a few suggestions that patients have used to ensure their success.

Commit to a food plan. This will help you not to be overwhelmed and take too much food at the table. Its best to make this plan when you are not hungry, so your judgement isn’t distorted. Remember to include alcohol consumption into this food plan, that has calories, and often sugar, as well!

Avoid going hungry for too long! Usually, we wait to eat during the holidays until the “big meal” where everyone is gathered together. This can create a situation, however, that encourages a lot of snacking and significant overeating. Remember to eat a few small meals that day before dinner so you are less tempted by all the food on the table. This will also help you stick to the Food Plan.

Slow your Roll! Slow down your eating speed during the holidays. This allows you to savor the flavors of smaller portions and to not feel pressured to get a second helping when everyone else is on their second (or third) helping of food.

Avoid starchy vegetables. This is just a matter of choosing vegetables other than the mashed potatoes at the table. It is a fairly simple change that will make a big impact on your blood sugar.

Go easy on the desserts. This is usually the hardest part for someone who is having to watch their sugar intake, because who doesn’t love pie?! If you feel you won’t be able to say no to the temptation of desserts during the holidays, try setting yourself up for success by bringing a dessert that is sugar-free. There are many really tasty options for substituting sugar in desserts, and these options are certainly worth looking up online!

If the holiday eating is a day-long event in your family, it’s important to know if you have a “see-food habit”… where if you SEE food, you EAT food. Often, when appetizers or snacks are out we are especially tempted to keep snacking between meals, which can significantly increase your blood sugars. If you are not able to keep the food out of sight between meals (because you are a guest), discuss with your host ahead of time what appetizers/snacks they are planning to have, and offer to bring a few options of your own. Again, there are great options online for diabetes-friendly appetizers.

Test your blood sugars periodically. This will keep you aware of where you are at through the holiday weeks and help you know what works for you

Set yourself up for success! Even if you are not in charge of cooking and are at the mercy of another host for food options, find out what the food menu is going to be in advance and offer to bring a version of some of your favorites that are diabetes-friendly. And remember to prevent yourself from getting too hungry and over-eating at mealtime. Good choices and good timing are two things that will set you up for success!

Foot and Ankle Pain is Not Normal!

Foot and Ankle Pain is Not Normal!

Foot and Ankle Fatigue is Not Normal

Many people working on their feet all day tend to accept foot pain and fatigue as just another part of life, but the truth is, its not. Having tired feet or pain in your feet after walking, running, or standing for the day is not normal and is certainly not something you should just accept as fact. Even better, there’s someone who can help- a podiatrist. Many people don’t realize that a podiatrist, a physician who specializes in foot and ankle conditions, could help them feel relief and get them back to the activities they love.

Here’s an example of some of the common conditions that can cause foot pain and tiredness;

Plantar Fasciitis: heel pain that typically begins upon first standing or waking up in the morning, though it can persist the rest of the day. Read more here:

Tibial Tendonitis: Arch or ankle pain that usually presents as tiredness or pain in the arch of the foot, with increasing instability feeling in the ankle. Read more here:

Bunions: pain and redness to the big toe joint. Usually gets worse with certain types of shoes. For more information on bunions:

Hammer Toes: Toes curling up and getting large knuckles? This is a common condition that is usually due to an overpulling of tendons in your foot. These tend to also indicate overall issues with the way your feet function. Read more here:

There are many other conditions that can cause foot and ankle fatigue and pain, and for some patients, they present with a combination of conditions, all of which contribute to one another. To do some research of your own, please visit our ‘Where does it hurt?’ page, or Make and Appointment on the site to discuss what we can do to get you back on your feet!

Choosing Shoes for your Fitness Goals

Choosing Shoes for your Fitness Goals

Choosing shoes for your New Year’s Fitness Goals

  • Evaluate your old tennis shoes BEFORE you start! Generally, for an active person, I recommend new tennis shoes every 9-12 months (or 350-400miles). If you are planning to start your new fitness routine using those 5-year-old shoes that you also use for gardening, do yourself a favor and get some new shoes. For most fitness activities, walking or running, you do not want to use worn out shoes that fold and twist.

The easiest way to check your shoes for this is to place one hand under the middle section of the shoe and one hand at the toes. Step one: while keeping the middle shoe straight, bend the toe section up towards the rest of the shoe. If this easily flexes backwards (or even touches the top of the shoe), you’re not getting enough support. Step two: while keeping the middle shoe stiff, try to roll the forefoot toe area of the shoe like you would a rolling pin. Again, if this is performed easily without much resistance, you will not get enough support from these shoes. Not enough support leads to tendinitis and shin splints, which can be discouraging if you are new to a fitness routine.

  • Don’t assume one pair of shoes is good for everything. Walking shoes are stiffer than Running shoes and for good reason. The demands on your feet are different whether you are walking or running, so make sure you plan for whatever type of activity you have committed yourself to doing.
  • You SHOULD NOT have to “break shoes in”. This is a common misconception among most people. Athletic shoes should feel comfortable right away.
  • When trying on shoes, if you wear orthotics, bring them with you. Also, you should bring your own socks. This will give you a true feel for the shoes as they will fit your feet
  • Measuring fit: The “rule of thumb” that you should have one thumb width (or two finger widths) between your big toe and the tip of the shoe needs to be used only when you are STANDING in the shoes and should be measured from your longest toe (which for some people, may be their second toe). This is important because our feet slide forward each time we step forward, even more so when running. So, to avoid damage and discoloration to toenails, make sure your toes have enough room.
  • Also, your heel should fit snuggly without slipping when you walk. This will prevent painful blisters on the back of the heel.
  • Buy your shoes at the end of the day. Our feet swell as the day progresses and you need to get the proper size shoe to accommodate this size change.
  • If you have flat feet, high arches, or a history of heel or foot pain/fatigue, you likely need to be evaluated by a podiatrist to determine what type of shoes you need. Every good brand of athletic shoe has different models that accommodate for various biomechanical issues, which is something a podiatrist can help you with.

Help! How did I get Shin Splints?

Help! How did I get Shin Splints?

“I started running and got Shin Splints- what now??”

One very common New Year’s resolution is to get in shape by running. While this can be a great new hobby, often people end up with injuries right at the start, discouraging them from pursuing running further. When a new running routine is implemented, initial injuries are usually related to doing too much, too quickly.  Shin Splints is no exception. Shin Splints is also known as MTSS (Medial Tibial Stress Syndrome) and generally occurs as pain to the inside front of the lower leg during or after running.

Pain to the front of the shin needs to be taken seriously as this pain can also indicate more serious conditions such as Compartment Syndrome or stress fractures to the leg bone known as the tibia. If you are experiencing pain to your shin, it is always advisable to seek medical advice from your podiatrist or orthopedist before continuing with your running routine.

But what IS shin splints??

Shin splints is the stress that is placed on the tibia bone as a result of microtears of the muscle off the bone, inflammation of the sheath around the bone, or just inflammation of the muscle itself. This is the result of inadequate stretching prior to your fitness activity. Not to worry, however, because shin splints is usually fairly easy to treat and does NOT mean you wont be able to run ever again!

Treatment for this condition involves immediately stopping the activity that is causing the pain (running, dancing, etc.), and changing your fitness routine temporarily to an activity that requires less stress on your legs. Examples of less stress activities include swimming, running in water, biking or walking.

Icing the front of your shin and stretching your calf muscles is also extremely important. I have patients do this at least twice daily for 2 weeks before slowly easing back into running. There are plenty of stretching exercises available online and should be simple to do. If the stretch looks like you need to be a contortionist to perform, don’t do it!

Evaluating your shoes is extremely important as well. Often, if you are using “broken in” or older tennis shoes to start running, you are not getting enough support. See our article on Choosing Proper Running Shoes for more information.

A common culprit for causing shin splints is running on a treadmill. When you start to ease back into running, I recommend patients try running outside and on different surfaces to see what is comfortable for them.

Taping your shin when running is another technique used very successfully for some people. Searches for “taping for shin splints” provide good demonstrations on these techniques.

And lastly, easing back into running should be performed as no more than a 10% increase per week. So, if you typically run 10 miles in a day (or week) the first week of running should be no more than 1 mile. The second week, no more than two miles, and so on.

Again, if you are unsure of how to treat this condition in any way, guidance from your podiatrist will make all the difference to your speedy recovery.

Heel Stretching Exercise

Heel Stretching Exercise

Heel Stretching for Plantar Fasciitis

Heel pain is a common and extremely frustrating problem, especially after beginning a new fitness routine. While you should consult a physician before attempting home treatments, to ensure that the problem is not more complicated, the most common treatment option is stretching of the calf muscles. This is just one example of the most common heel stretch I have my patients do. There is a lot of information on stretching on the web, but if you appear to need a lot of flexibility to perform the stretch, it is likely unnecessary and not a good option for you.

Heel Stretching:

  • Stand an arm’s length from the wall, placing both palms on the wall in front of you.
  • Place your right foot extended out behind your left foot, making sure to keep both feet facing forward, as if there’s an invisible line between them.
  • Keep your right knee straight and right heel on the ground. Slowly and gently bend your left leg forward at the knee towards the wall. You will feel the pull in the back of your right calf.
  • Hold the stretch for 30 seconds.
  • Switch the placement of your feet and repeat for a stretch in the left calf.

For more information on Plantar fasciitis, click the blog article for heel pain FAQ

Feels like I’m walking on stones! – Porokeratoses and painful foot callus

Feels like I’m walking on stones! – Porokeratoses and painful foot callus

Ever feel like you are walking on a stone in the ball or heel of your foot? Feel a small painful foot callus but it doesn’t seem like a big enough callus to be causing SO much pain? Its worth getting looked at by your podiatrist.

One of the most common, and easily treatable complaints that people come into my office for are small lesions called porokeratoses. Generally, the complaints patients present with are feeling like they are walking on a painful stone or thorn on the ball or heel of their foot, they don’t recall stepping on anything to cause this pain, and while there is a small callus in the area of pain, it does not seem to help when the patient grinds the callus down at home.

Causes of porokeratoses is debated, but the most common assumed cause is that of clogged sweat glands in the foot. That’s right, we have sweat glands in our feet. Approximately 250,000 sweat glands actually. And sometimes when you combine the pressure and friction on the foot with debris and dead skin, those glands will clog. Because the gland is so deep in the skin layers, this pain feels like it’s very deep down in the foot, which is why the grinding down of the surface callus down does not provide relief.


Many patients try to just live with this pain or assume they have plantars warts and try to treat them at home, unsuccessfully. Eventually, patients give up and limp into the office after months of home treatments only to find their pain is easily remedied.

Treatment options involve cushioning the area of pain with insoles and controlling the amount feet sweat by using drying powders. However, those treatment options are usually best used as preventative medicine once you’ve had the area treated by your podiatrist. Your podiatrist will likely perform curetting of the lesion which should not cause you pain. Other options your doctor may offer for treatment are injections into the area or use of diluted acids to get rid of the clogged sweat gland entirely.

Whichever treatment option you choose with the advice of your physician, it is important to remember that this condition is likely to return and require periodic management. Patients who are more susceptible have feet that sweat more. Sweating can be exacerbated by colder-weather, closed in shoes and foot fungus. It will be important to use drying powders or sprays along with antifungals to help decrease the incidence of this condition.

For more information on conditions that may be making your feet hurt, click our interactive “Where does it Hurt” page:

Diabetes Informational Resources

Diabetes Informational Resources

Whether you are new to a diagnosis of diabetes or have ever wondered what you could do better to help manage your longstanding diabetes, scouring the internet for useful information through all the advertisements and poor advice can be a daunting task. In this quick post, I have tried to help sort through the endless information to direct you towards sites with diabetes information I feel is valuable for patients.

If you need an appointment or have not yet established care with a podiatrist, it is important to do so. Click here for information on what services Peninsula Podiatry can offer you:

General Diabetic Information Sites

Diabetes Self-Management

-A great site with multiple categories of information pertaining to management of diabetes. Everything from choosing diabetic shoes to blood sugar management and great recipe options.

-Site for the American Diabetes Association. This site contains useful comprehensive and reliable free information on both Type 1 and Type 2 diabetes as well as resources for nutrition and meal planning.

Diet Control Information and Diet Planning Sites

-The American Diabetes Association also has this site called MyFoodAdvisor. It helps you plan meals, provides shopping lists and recipe options for healthy living and blood sugar control. I’ve had many of these recipes personally- they are delicious!

-If you are trying to control your diet, whether for losing weight or managing diabetes, one of the best ways is to come up with a diet plan. This source from the Mayo Clinic helps breakdown into simple terms which foods to enjoy and which to avoid.

-Very indepth guide to foods, serving sizes and meal planning. This is in a downloadable pdf.